After the death

What do we need to do?

• Introduce (or revisit) the following and explain the need for these, as far as possible trying to maintain continuity of care:
  • registration
  • post-mortem
  • funeral arrangements
  • clinical follow up
  • Perinatal Mortality Review.
• Ensure local guidelines set out clearly who should lead these discussions and how staff in these roles should achieve continuity.
• Plan at least an hour for this discussion and ensure it takes place in a quiet, private place.
• This is complex and challenging information for the family. After you have explained, check they have understood what is involved, for example by using the Teach Back method from The Health Literacy Place. Remember you may need to revisit the conversation.
• Document the discussion in the baby’s medical record.
• Try to summarise in written information the processes and forms the family will need to engage with.
• Begin to discuss arrangements for discharge and find out the family’s wishes.
• Explain that a form can be added to the mother’s record to explain to staff that her baby has died if she wishes - a template form is available.

Review and follow up

• Inform parents about the process of perinatal mortality review and invite them to become involved in the review process and refer to the PMRT's parent engagement materials.
• Ensure that the family know who their key contact is for the review period and, wherever possible, ensure this person is the same key contact they had during their baby’s parallel and end of life care planning.
• Explain that the family will be given flexibility on the timing of when and how they contribute their thoughts, comments and questions to the review. Check that the family are comfortable with where the appointment will take place. Explain that during the review process they will be asked about their preferences on how and when they would like to receive and discuss the review report.
• Explain the purpose of clinical follow up, both what the family can expect and what the follow up does not cover, and who can attend. Check the family are comfortable with where the appointment will take place. Ensure enough time has been allowed for this appointment. This follow up should be led by the team providing continuity of obstetric and midwifery care. If at all possible this appointment should also include feedback from the Perinatal Mortality Review.

Post mortem examination

• Remember to keep within the scope of your practice when providing information, explaining procedures or answering questions. Be prepared to consult with or refer to suitably trained colleagues whenever necessary.
• Sensitively explain why a post mortem is recommended. You may find the NES video for professionals Discussing Authorised (Hospital) Post Mortem Examination after Stillbirth or Neonatal Death useful preparation.
• Tell the parents if the post mortem examination will take place at a different hospital and explain where and why.
• Explain that all transport arrangements and handling of the baby will be respectful and caring and who will be responsible for this.
• During the authorisation process, inform the family of the likely timescales for the return of the baby’s body and the results.
• Identify a named contact within pathology who will be responsible for following up on results.
• Ensure any small objects or keepsakes such as a hat or cuddly toy that the family sent with their baby are returned following the investigation.
• Ensure that you are aware of relevant statutory death review processes and that these link with your Board’s internal processes – e.g. morbidity and mortality (M&M) meeting, Adverse Event Review, Perinatal Mortality Review – and inform the family as appropriate.

Registration and certification

• Provide the family with the medical certificate certifying the neonatal death, having carefully checked that the information is accurate.
• In addition to providing written information, sensitively explain the national death registration process, including where and how to register, and the need to register both the birth and the death.
• Ensure the family have any other information the registrar will need.

Funerals

• Provide the family with information around the legal requirements and local funeral directors.
• Explain that baby funerals are free in Scotland, although there may be a charge for a plot and there will be a charge for a headstone.
• Let the family know that a financial support payment is available to families on low income via Social Security Scotland.
• Bear in mind, and facilitate where possible, different personal, religious and cultural needs. Do not make assumptions.
• Discuss the options for urgent burial and cremation with the family where appropriate.
• Offer to refer the family to the spiritual care/chaplaincy team.
• Inform all primary and secondary healthcare staff involved in the care of the family and baby that the baby has died, including any referring units before discharge and within 24 hours.
• Record a neonatal death on the risk reporting system.
• Record all decisions made in the baby’s record, including where information is declined, or no decision is made.

How will we know we have achieved our aim?

Families tell us they felt the right person spoke to them, in the right way, and they understood what the processes were, why they happened and the choices they had.

Staff will say they feel confident and competent when discussing investigations and processes after death.

Go to Preparing for discharge